Endoscopic Surveillance of Intestinal Metaplasia of the Esophagogastric Junction: A Decision Modeling Analysis
Year: 2024
Type: article
Abstract: INTRODUCTION: The incidence of esophagogastric junction adenocarcinoma (EGJAC) has been rising. Intestinal metaplasia of the esophagogastric junction (EGJIM) is a common finding in gastroesophageal reflux (irregular Z-line) and may represent an early step in the development of EGJAC in the West. Worldwide, EGJIM may represent progression along the Correa cascade triggered by Helicobacter pylori . We sought to evaluate the cost-effectiveness of endoscopic surveillance of EGJIM. METHODS: We developed a decision analytic model to compare endoscopic surveillance strategies for 50-year-old patients after diagnosis of non-dysplastic EGJIM: (i) no surveillance (standard of care), (ii) endoscopy every 3 years, (iii) endoscopy every 5 years, or (iv) 1-time endoscopy at 3 years. We modeled 4 progression scenarios to reflect uncertainty: A (0.01% annual cancer incidence), B (0.05%), C (0.12%), and D (0.22%). RESULTS: Cost-effectiveness of endoscopic surveillance depended on the progression rate of EGJIM to cancer. At the lowest progression rate (scenario A, 0.01%), no surveillance strategies were cost-effective. In moderate progression scenarios, 1-time surveillance at 3 years was cost-effective, at $30,989 and $16,526 per quality-adjusted life year for scenarios B (0.05%) and C (0.12%), respectively. For scenario D (0.22%), surveillance every 5 years was cost-effective at $77,695 per quality-adjusted life year. DISCUSSION: Endoscopic surveillance is costly and can cause harm; however, low-intensity longitudinal surveillance (every 5 years) is cost-effective in populations with higher EGJAC incidence. No surveillance or 1-time endoscopic surveillance of patients with EGJIM was cost-effective in low-incidence populations. Future studies to better understand the natural history of EGJIM, identify risk factors of progression, and inform appropriate surveillance strategies are required.
Institutions: Icahn School of Medicine at Mount Sinai, Columbia University Irving Medical Center, University of California San Diego, VA San Diego Healthcare System, University of Michigan, Michigan Medicine, VA Center for Clinical Management Research, University of Utah, Cleveland Clinic, Herbert Irving Comprehensive Cancer Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Defense, U.S. Department of Veterans Affairs, Division of Cancer Prevention, National Cancer Institute, American Gastroenterological Association, National Institutes of Health, National Cancer Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences, San Diego Digestive Diseases Research Center, School of Medicine, University of California, San Diego
Awards: G2413374417, G2830540355, Early Targets in Progression of Barrett's Esophagus to Esophageal Adenocarcinoma, G399984587, A Personalized Approach to Targeted Esophageal Cancer Screening, G5182824200, G520654062, G6709894135, G6945158567, G7484007215, G7575408168, Clinical and Translational Science Award, San Diego Digestive Diseases Research Center, Coordinating Center for the Program on the Origins of Gastroesophageal Cancers, Institutional Career Development Core, The Columbia University Digestive and Liver Disease Research Center, Comparative modeling of gastric cancer health drivers and prevention in the US and globally
OpenAlex ID: W4391256273